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Presentation Title
1
Responding to Substance Use Disorders and
Trauma among Parents Involved in the Child
Welfare System
National Conference on Child Abuse and Neglect
May 2,2014
Kim Bishop-Stevens, LICSW
Terri Bogage, LICSW
Norma Finkelstein, Ph.D
Massachusetts Department of Children and
Families
Kim Bishop-Stevens, LICSW
Substance Abuse Manager
DCF at a Glance
Organizational Structure
4 Regions: Regional Offices / Regional Directors
29 Area Offices: Director of Areas (oversee 2 offices), Area Clinical
Managers, Area Program Managers, Supervisors, Social Workers
Units: Intake – Screening (Hotline for after hours) &
Investigations/Initial Assessment, Short Term Stabilization,
Ongoing
Specialty Units: Substance Abuse, Mental Health, Domestic
Violence, Medical, Housing, Education, Legal, Fatherhood,
Community Connections, Training
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Department of Children and Families
83,805 reports (51A’s) received
• 54% are screened in for Investigations/Initial
Assessment
At any given time during the year:
• 67,334 total consumers
• 19,024 open clinical cases
• 34,114 children under 18
• 7,302 were in placement (21%)
Calendar year 2012, DCF Internet
Approximately 68% of DCF cases involve parental substance abuse
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DCF Ongoing Initiatives
DCF Substance Abuse Unit
Policy Development
Tool Kit
Training
Family Resource Centers
Massachusetts Child Trauma Project
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DCF and DPH Collaboration
Governor’s Interagency Council on Substance Abuse
and Prevention
Regional Partnership Grants
Family Residential Treatment – Centralized Intake
DCF Intake Policy and Medication Assisted Treatment
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Presentation Title
Nurturing Program for Families in
Substance Abuse Treatment and Recovery
(included in the National Registry of Evidence-based
Programs and Practices)
Terri Bogage, LICSW
Director, Children and Family Services
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Presentation Title
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Why the Nurturing Program?
People parent based upon their own parenting
experiences
Parents cannot give what they don’t have
Knowing how to nurture comes from being nurtured
Internalizing nurturing experiences helps parents to
recognize the emotional needs of their children
Presentation Title
History/Philosophy
Trauma-informed curriculum that integrates substance
use/abuse, recovery, mental health issues, parenting,
and child development
Curriculum origin and development, components,
theoretical background
Erickson’s eight themes of growth spanning life cycle
The Stone Center’s Relational-Cultural Theory
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Presentation Title
Curriculum Origin
Developed through PPWI-CSAP demonstration project,
1990-1995
Piloted at 2 residential women & children’s programs
Based on Dr. Stephen Bavolek’s Nurturing Program for
Parents of Children Birth to 5 – on CSAP Promising
Practices
Well documented, aimed at reducing abuse & neglect;
had evaluation instrument - AAPI
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Presentation Title
Relational/Cultural Model
Shifts emphasis from separation to “Relational Self” as
basis for growth and development
Connections are fundamental to psychological growth
and healing
Goal of development is to enhance connection
Development is toward interpersonal connection &
interaction
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Presentation Title
“Women’s sense of personhood is grounded in the
motivation to make and enhance relationships to others.
We observe that women tend to find satisfaction,
pleasure, effectiveness, and a sense of worth if they
experience their life activities as arising from and
leading back into a sense of connection with others.”
-Jean Baker Miller
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Presentation Title
Guiding Values of
Nurturing Program
Parenting is a relationship,
not only a set of skills
Nurturing oneself is the first
step toward nurturing
others
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Presentation Title
Guiding Values of the Nurturing Program
Love of life & learning
Respect for self, others & the environment
Fun & laughter
Recovery happens in families & in relationships, as
well as in the individual
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Presentation Title
Purpose
To address the impact of substance abuse, mental illness
and trauma on parenting and the parent-child
relationship
Begin with focus on the parent and challenges
Build the relationship between parent and child
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Presentation Title
Responds To
Array of learning styles
• Literacy
• Multiple intelligences
Exploration of cultural
heritage
• Providing opportunities
to explore & appreciate
both own heritage &
heritage of other
participants
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Presentation Title
Topics Hope
Growth & trust
Families
Feelings
Making connections
• Communication
• Problem solving
• Body talk
• What babies teach us
Self-esteem
Building structure
• Managing stress
• Setting boundaries
• Schedules & routines
• Safety
Guiding behavior
Knowing our values
Recovery: love & loss
Having fun
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Presentation Title
Nurturing Program 3rd Edition
Trauma-informed curriculum that integrates substance use/abuse,
recovery, mental health issues, parenting and child development
3 new sessions for working with fathers & men
Incorporates concepts:
• Child-Parent Psychotherapy (Alicia Lieberman and Patricia Van
Horn)
• Reflective Functioning (Nancy Suchman, et al.; Peter Fonagy)
Guide for individual use
• In home-based, residential or outpatient settings
• With individuals or individual families
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Presentation Title
The sessions are designed to enhance the existing
Nurturing Program for Families in Substance Abuse
Treatment and Recovery curricula
May serve as alternatives for three other sessions
• Families and Substance Abuse
• Body Talk
• Schedules and Routines
Being a Father Sessions
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Presentation Title
Nurturing Program Individual GuidePurpose:
To expand the settings for using the NP
• In-home treatment
• Individual Counseling
• Family Therapy
To be used as a stand-alone treatment or as a supplement to an
NP group
To provide complimentary activities, alternative exercises, and
ideas on how to modify the NP
To respond to the various needs of the clients, the strengths of
the facilitators, and the guidelines of the treatment settings
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Presentation Title
Work with Children
Working on children’s curriculum to use simultaneously
while parents participating in group
• Based on children’s sub-study of Women, Co-occurring
Disorders and Violence study
Family Activities Manual to Nurture Parents and Children
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Presentation Title
Evaluation
Adult-Adolescent Parenting Inventory (AAPI-2)
Session Evaluations may also be used, such as surveys
and assessments
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Presentation Title
AAPI
Core domains:
• Appropriate developmental
expectations
• Empathy
• Alternatives to corporate
punishment
• Appropriate roles
• Oppressing children’s power &
independence (added 1999)
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Presentation Title
Participant’s EvaluationsFamily Relationships & Parenting:
“Most of what I learned had to do with ways I thought I should parent &
that there really is no rulebook or manual to being a good parent. I also
spent time learning about my child’s boundaries.”
“I’ve learned a lot of new ways to discipline, comfort, nurture, trust, love,
care.”
“[I’ve learned] patience with my children, to think on their level.”
“I have learned that my child will learn different skills on her own time &
not mine, and that I need to be patient & loving & supportive no matter
what.”
“I don’t yell as much; I use time-out instead of hitting.”
“I don’t have to yell or get stressed out with my kids. I have ways to
relate.”24
Presentation Title
Participant’s Evaluations
I learned:
“How to have fun as a clean & sober person, how to recognize
certain feelings & situations & how I can deal with them; how to
interact with other people, & how to nurture myself, my family
& friends, & feel comfortable with it.”
“How to handle many of life’s everyday issues & problems.”
“What nurturing is, how to nurture & care for myself as well as
others; that I am a truly worthwhile human being who deserves
safety, respect & happiness.”
“To take the initiative in my recovery.”
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Presentation Title
Facilitation Skills
Each segment opens with information for group
facilitator
Staff responsible should have the following experience:
• A solid understanding of substance use and its effects
on families
• Fundamental knowledge regarding parent-child
relationships and child development
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Presentation Title
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Developing Trauma-Informed Organizations
National Conference on Child Abuse and Neglect
Norma Finkelstein, Ph.D
Executive Director
Presentation Title
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Family-Centered, Trauma-
Informed Treatment
Is based on an
understanding of impact of
violence and victimization
on…
Each family member
Their relationships to each
other
The family as a whole
Presentation Title
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Staff knowledgeable
regarding impact of
violence; trained to
behave in ways that are
not re-traumatizing
All family members have
access to trauma-specific
interventions
Presentation Title
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Trauma-Informed
Treatment Focuses On:
Safety (physical and
emotional)
Trustworthiness
Voice/Choice
Collaboration/ Mutuality
Empowerment
Fallot & Harris, 2006
Presentation Title
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Institute for Health and Recovery’s
Developing Trauma Informed Organizations:
A Tool Kit
Presentation Title
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Tool Kit Contents
Principles for an Integrated Trauma-Informed Services
System
Template for Developing a Trauma Integration Strategic
Plan
Sample Trauma Policies
Trauma-Informed Organizational-Assessments
Staff Practice Survey
Trauma Informed Supervision Guides and Tools
Presentation Title
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Steps Involved in
Organizational Change
1. Identify champion for change—
Trauma Champion
2. Form change team
3. Team identifies and prioritizes
targets for change
4. Develop Trauma Integration
Strategic Plan
5. Conduct periodic self-assessments
6. Implement changes over a period
of time
Presentation Title
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How Change Teams Work
Build connection at multiple levels of organization with
information flowing between levels
• Administrators, middle management, direct care
staff, peer leaders
Bring together diverse constituencies affected by
proposed changes
• Direct care staff, participants (consumers), peer
leaders
Presentation Title
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Using the Tool Kit
Organization forms a Trauma Integration Team from all
levels of organization
Trauma Integration Team collects data
• To assist in setting goals and priorities
• To monitor change over time
Presentation Title
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Using the Tool Kit
Trauma Integration Team
Completes Trauma Integration Assessment, choosing
ratings by consensus
Administers Staff Practice Survey anonymously. How
are staff doing with respect to: Staff Safety, Staff
Empowerment, Self-Care, Knowledge and
Competence, Trauma-Informed Attitudes, Trauma-
Informed Practice
Presentation Title
37
Using the Tool Kit
Template for Creating Trauma Integration Plan
1. Trauma Integration Team uses template to identify
goals in different areas (i.e., physical environment,
staff training)
2. Goals are prioritized
3. Objectives, target dates and person(s) responsible for
implementation developed
4. Team continues to move through goals at reasonable
pace
Presentation Title
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Trauma Informed Supervision
After staff trained in trauma-informed practice,
Supervision Guides used to train staff in trauma-
informed supervision
Supervisor Self-Check used by supervisors to self-assess
their provision of supervision in a trauma-informed
manner
Supervisee Learning Review used by supervisors to
monitor trauma-informed competencies in supervisees
over time
Presentation Title
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Secondary Trauma
Changes in the inner
experience of service
providers that come
about as a result of
empathic engagement
with the participant’s
experience of trauma
Presentation Title
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Impact of Secondary Trauma
Changes in:
Beliefs about self,
others, the world
Sense of trust or sense of
esteem in self or others
Perception of safety of
self or others
Feeling connected
Sense of control
Presentation Title
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Trauma Informed
Supervision
Creates a safe relationship
so that staff can discuss
concerns
Builds reflective capacity
and trauma competence
Normalizes impact of
secondary trauma
Helps identify triggers
Presentation Title
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Trauma Informed
Supervision
Suggests Strategies
Use of same skills as participants:
emotional self-awareness,
grounding, self-soothing
Self-Care Plans: provide resources
for self-care such as: peer support,
time off, stress management
resources, physical activities,
counseling
Presentation Title
How the Agency Can Help
Educate all staff on vicarious traumatization
Recognize that staff may be trauma survivors
Incorporate concept into supervision and case
discussions – make it safe to talk about
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Presentation Title
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Challenges of a Culture Shift
Welcoming disagreement
Do staff feel safe and empowered?
Can staff talk about the impact of the work on
themselves?
How safe are staff with each other?
Peer inclusion- finding appropriate boundaries, slowing
down, allowing personal experience in the room, focus on
strengths
Balancing patience and accountability
Presentation Title
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“I am just learning, I may have been here 8 years but I am
still, over the last year I’m learning more about trauma in
women and being more caring and less critical. I’m not
trying to get them to do my program anymore, I’m trying to
help them do their own program and teach them, that’s
what I do and same thing with the kids… I’m a lot softer
this past year than I have ever been.”
Staff Response
Presentation Title
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Tool Kits
IHR’s Developing Trauma Informed Organizations: A Tool Kit
(second edition)
www.healthrecovery.org click on “services and products”, click on
“products”, click on “trauma”, click on “see more trauma products”
The Trauma-informed Toolkit
© 2008 Klinic Community Health Centre, Canada
www.trauma-informed.ca
Trauma Informed Organizational Toolkit for Homeless Services
www.familyhomelessness.org/media/90.pdf
Additional Resources
Presentation Title
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Websites
Community Connections
www.communityconnectionsdc.org
National Center on Trauma Informed Care
www.samhsa.gov/nctic/
National Child Traumatic Stress Network
www.nctsn.org
Listserv
5.73"
Additional Resources
